Characteristics, diagnosis, treatment and prognosis of double primary hepatic cancer: experience based on a series of 12 cases

Double Primary Hepatic Cancer (DPHC) which refers to synchronous hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) coexisting in the same liver, has rarely been reported. Here we discussed the clinical characteristics, diagnosis, treatment, and prognosis of DPHC based on an analysis of 12 DPHC cases. Meanwhile, data of 60 HCC cases and 60 ICC cases were collected at a ratio of 5:1 and with matched age and gender to DPHC in the same period. A total of 4,626 cases of primary liver cancer were screened, and the proportion of DPHC was approximately 0.26%. Hepatitis B Virus prevalence in the DPHC group (83.3%) was higher than that in the ICC group (38.3%). Lymph node metastasis was more common in the DPHC group (16.7%) compared to the HCC group (1.7%). The median disease-free survival (DFS) and overall survival (OS) for DPHC were 6.0 +/- 2.6 months and 15.0 +/- 1.7 months, respectively. Pathological diagnosis indicated a significant effect of preoperative adjuvant transarterial chemoembolization (TACE) on HCC, but limited efficacy on ICC. Both alpha fetoprotein and carbohydrate antigen 19-9 levels were elevated in the DPHC group. In conclusion, the preferred treatment for DPHC is radical resection and regional lymphadenectomy. Preoperative TACE is effective for DPHC with large HCC components. The prognosis for DPHC is marked by high recurrence and high mortality.